HomeMy WebLinkAboutSWP273383 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS 33�3
DATE: CONTACT: In() EXT. I
FILE STATUS ❑NEW OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION ❑ My Work Space: 10 File Bay Shelf#: 0 Other:
PROJECT NAME/FILE TITLE: C C a r RNV-pr �r��c pqr k-
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DESCRIPTION OF PROJECT:
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UTILITY PERMIT# U d(a O� � A## C)�Q 1--7 2�j WO# S
ADDRESS/STREET NAME(S): 9jI cg, c�C I �QCj A Vt� Sw
DEV: 1'i ; CNTR ;OWN: o I I ; CNSLT/ENG: L.
OTHER ALIASES: L�nr4 nrSS
Circle Size of Waterline: 8" 0" 12" Circle One: Replace/Extension
Circle Size of Sewerline: a
10" 12" Circle One: ew Replace/Extension
Circle Size of Stormline: 18" 24" Circle One w Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
q/IUD ❑ ❑
(off site improvements) (include TESC)
Sk"TRO ❑ ❑
(Signalization,Channelization,Lighting)
R---'WWP ❑ ❑
(sanitary sewer main,include basin name)
P---"'WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
C' SWP ❑ ❑
(CIP onlyxinclude basin name)
01 PLR (For Developer Files Only) ❑ getter only)
PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MAINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made
336
I O- -
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